Numerous studies have examined the effects of caffeine intake on fertility and pregnancy. Most studies found that moderate
caffeine intake does not affect fertility or increase the chance of having a miscarriage or a baby with birth defects; some studies
did find a relationship between caffeine intake and fertility or miscarriages. However, most of those studies were judged to be
inadequate because they did not consider other lifestyle factors that could contribute to infertility or miscarriages. The
Organization of Teratology Information Services (OTIS) stated that there is no evidence that caffeine causes birth defects in
humans. Groups such as OTIS and Motherisk agree that low caffeine intake (<150 mg/day or 1-½ cups of coffee) will not
likely increase a woman's chance of having a miscarriage or a low birth weight baby. Motherisk recommends that caffeine
intake by pregnant women not exceed 150 mg/day whereas OTIS stated that moderate caffeine intake of 300 mg/day
(equivalent to about 3 cups of coffee) does not seem to reduce fertility in women or increase the chances of having a child with
birth defects or other problems. Caffeine can enter breastmilk, and high amounts can cause the baby to become wakeful and
agitated. The American Academy of Pediatrics recommends that nursing women limit caffeine intake, but states that no harm is
likely to occur in a nursing child whose mother drinks one cup of coffee a day. OTIS recommends that pregnant and nursing
women drink plenty of water, milk, and juice and not substitute those fluids with caffeinated beverages.

Caffeine and Fertility

Numerous studies have been conducted to determine the effects of caffeine intake on fertility in women. The International Food
Information Council (IFIC) has described and made conclusions about the following studies (IFIC July 1998).

One small study in 1988 suggested that caffeine, equivalent to the amount consumed in 1-to 2-cups of coffee
daily, might decrease female fertility. However, the researchers acknowledged that delayed conception could be
due to other factors they did not consider, such as exercise, stress or other dietary habits. Since then, larger,
well-designed studies have failed to support these findings.

In 1990, researchers at the Centers for Disease Control and Prevention and Harvard University examined the
association between the length of time to conceive and consumption of caffeinated beverages. The study involved
more than 2,800 women who had recently given birth and 1,800 women with the medical diagnosis of primary
infertility. Each group was interviewed concerning caffeine consumption, medical history and lifestyle habits. The
researchers found that caffeine consumption had little or no effect on the reported time to conceive in those
women who had given birth. Caffeine consumption also was not a risk factor for infertility.

Supporting those findings, a 1991 study of 11,000 Danish women examined the relationship among number of
months to conceive, cigarette smoking and coffee and tea consumption. Although smokers who consumed eight
or more cups of coffee per day experienced delayed conception, nonsmokers did not, regardless of caffeine
consumption.

The March of Dimes (MOD 2002) notes that during pregnancy, caffeine easily passes from the mother to her unborn child
through the placenta. Because the systems for breaking down and eliminating chemicals are not fully developed in the unborn
child, blood levels of caffeine may remain elevated for longer periods in the unborn child compared to the mother. OTIS (OTIS
2001) notes that, "...higher amounts of caffeine could affect babies in the same way as it does adults. Some reports have stated
that children born to mothers who consumed >500mg/day were more likely to have faster heart rates, tremors, increased
breathing rate, and spend more time awake in the days following birth."

The effects of caffeine intake on miscarriages, birth defects, and low birth weight have been studied, and different results were
obtained in the various studies. The International Food Information Council (IFIC) has described and made conclusions about
the following studies (IFIC July 1998).

Recently, researchers from McGill University in Montreal published a study showing a relationship between
caffeine intake and miscarriage. While caffeine intake before and during pregnancy appeared to be associated
with increased fetal loss, the authors failed to account for a number of factors that could result in a false
association, including effects of morning sickness or nausea*, the number of cigarettes smoked and amount of
alcohol consumed.

Just prior to the McGill study, a research team from the U.S. National Institute of Child Health and Human
Development conducted a study of 431 women. The researchers monitored the women and the amount of
caffeine they consumed from conception to birth. After accounting for nausea, smoking, alcohol use and maternal
age, the researchers found no relationship between caffeine consumption of up to 300 mg per day and adverse
pregnancy outcomes, including miscarriage.

Additionally, in 1992, researchers analyzed the effects of cigarettes, alcohol and coffee consumption on pregnancy
outcome in more than 40,000 Canadian women. Although alcohol consumption and smoking tended to have
adverse effects on pregnancy outcome, moderate caffeine consumption was not associated with low birth weight
or miscarriages.

Studies published during the 1980s also support the conclusion that moderate caffeine consumption during
pregnancy does not cause early birth or low birth-weight babies. A review of more than 20 studies conducted
since 1980 found no evidence that caffeine consumption at moderate levels has any discernible adverse effect on
pregnancy outcome.

A seven-year study of 1,500 women examined caffeine use during pregnancy and subsequent child development.
Caffeine consumption, equivalent to about 1 1/2 - 2 cups of coffee per day had no effect on birth weight, birth
length or head circumference. Follow-up examinations at ages eight months, four and seven years also revealed no
effects of caffeine consumption on a child's motor development or intelligence.

In the early 1980s, the U.S. Food and Drug Administration (FDA) conducted a study where rats were force-fed
very high doses of caffeine through a stomach tube. While the results prompted an advisory to pregnant women to
avoid caffeine, the study was criticized as not being representative of the way humans consume caffeine.

In 1986, FDA researchers carried out another study, in which rats consumed high doses of caffeine in their
drinking water. At the conclusion of the second study, the FDA found no adverse effects in the offspring,
contradicting the agency's earlier findings.

Major studies over the last decade have shown no association between birth defects and caffeine consumption.
Even offspring of the heaviest coffee drinkers were not found to be at higher risk of birth defects.

Groups such as OTIS, March of Dimes, and Motherisk reviewed studies examining caffeine intake during pregnancy and are in
agreement that high caffeine intake (>300 mg/day, equivalent to more than 3 cups of coffee/day) should be avoided during
pregnancy. There is also general agreement that low caffeine intake (<150 mg/day, about 1-½ cups of coffee) during pregnancy
is not likely to harm the unborn child. However, there is some disagreement regarding moderate caffeine intake.

Following a statistical analysis of studies examining caffeine intake in pregnant woman, Motherisk (Motherisk 2000) stated,
"Our results suggest a small but statistically significant increase in risk of spontaneous abortion and low birth weight babies in
pregnant women consuming more than 150 mg of caffeine per day. Pregnant women should be encouraged to be aware of
dietary caffeine intake and to consume less than 150 mg of caffeine a day from all sources throughout pregnancy."

Subsequent to their review of caffeine studies, OTIS (OTIS 2001) stated that "Recent reports suggest that low to moderate
consumption of caffeine does not increase the risk for miscarriage. A few studies have shown that there may be an increased
risk for miscarriage with high caffeine consumption (>300 mg/day), particularly in combination with smoking or alcohol, or with
very high levels of caffeine consumption (>800 mg/day). OTIS (OTIS 2001) goes on to say that, "In humans, even large
amounts of caffeine have not been shown to cause an increased chance for birth defects." OTIS concluded that,
"Most experts agree that moderation and common sense are the keys for consuming caffeinated items during pregnancy.
"Moderate" caffeine consumption is approximately 300mg/day, which is similar to 3 cups of coffee. It is also important for
pregnant women to drink sufficient quantities of water, milk and juice. These fluids should not be replaced with caffeinated
beverages."

*Note: The IFIC stated that, "For some women, nausea - "morning sickness" - is a common experience
during pregnancy. Though this phenomenon is unpleasant, researchers believe it's a positive sign of a healthy pregnancy.
During a successful pregnancy, hormone levels are high, thus increasing the likelihood of becoming nauseated. If you're
nauseated, you're not likely to consume all your favorite foods and beverages, including caffeine-containing beverages, so you
may resort to a diet of saltines and sips of water. Because nausea affects what is consumed during pregnancy, researchers
usually account for this when studying the effects of certain foods and food ingredients on pregnancy outcome. In the case of
nausea's effects on caffeine consumption, it appears that moderate caffeine consumption is an incidental, rather than a causative,
for miscarriages."

Caffeine and Breast Feeding

Caffeine can enter the breast milk of nursing mothers (IFIC July 1998). According to the American Academy of Pediatrics
(AAP 2002), "Caffeine tends to build up in babies' systems because their bodies cannot get rid of it very easily. A morning cup
of coffee is not likely to harm your baby, but too much caffeine can cause problems such as poor sleeping, nervousness,
irritability, and poor feeding. Try using decaffeinated coffee and tea and avoid colas and other carbonated drinks that have
added caffeine." OTIS (OTIS 2001) states that, "women should remain well hydrated with water, juice and milk while
breastfeeding."

Caffeine Levels in Foods and Drinks

Levels of caffeine typically found in drinks and foods are listed in the following table obtained from the IFIC website.

Item

Milligrams of Caffeine

Average

Range

Coffee (5-oz. cup)

Brewed, drip method

115

60-180

Brewed, percolator

80

40-170

Instant

65

30-120

Decaffeinated, brewed

3

2-5

Decaffeinated, instant

2

1-5

Teas (5-oz. cup)

Brewed, major U.S. brands

40

20-90

Brewed, imported brands

60

25-110

Instant

30

25-50

Iced (12-oz. glass)

70

67-76

Some soft drinks (6 oz.)

18

15-30

Cocoa beverage (5 oz.)

4

2-20

Chocolate milk beverage (8 oz.)

5

2-7

Milk chocolate (1 oz.)

6

1-15

Dark chocolate, semi-sweet (1 oz.)

20

5-35

Baker's chocolate (1 oz.)

26

26

Chocolate-flavored syrup (1 oz.)

4

4

Source: U.S. Food and Drug Administration and National
Soft Drink
Association